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Thursday, May 22, 2008
News “Last Time Cascadia’s Predecessor Pulled Something Like This I Knew Two People Who Committed Suicide…”
Posted by on Thu, May 22 at 11:23 AM
That was mental health advocate Marian Drake, addressing County Chair Ted Wheeler yesterday afternoon during a two-hour meeting to talk about the financial collapse of the county’s giant mental health-care provider, Cascadia.
WHEELER: Met with mental health advocates yesterday…
Since the financial problems hit, many of Cascadia’s clients have been worried about the future of their housing and psychiatric services. Wheeler’s director of County Human Services Joanne Fuller said there’s still no firm plan for what to do with Cascadia next, but she said it’s likely Cascadia will be “a much smaller organization” once the county’s plan is put into effectit’s likely, too, that Cascadia’s services will be farmed out to other providers across the county, she said. However, “the clients are our top priority,” she said. “We don’t want to destabilize things by moving quickly to make changes that then have negative impacts and hurt consumers.”
“Because of all the instability around services, there’s angst around that,” said Beckie Child of the Mental Health Association of America. “My concern is that people will go into crisis because of all this angst.” “It’s very difficult for Cascadia to build trust with a client if they see a doctor and don’t know if they’re going to see them again,” Child continued.
“I’m less concerned about myself but more for the less capable clients,” said Ryan Hamit, also a Cascadia client and Client Counsel President of the Garlington Center, one of Cascadia’s centers. “One person was yelling about things, another person was yelling and screaming, and shouting, ‘my house, my house, my house’,” he said, bursting into tears. “They don’t want to transition out of where they are now. And then I walked into a meeting and they made an announcement about a new CEO on May 1st, and it’s been quite shocking…” he trailed off.
“If I went to a new provider I’d feel like I was in a strange land, because there’s people I’ve known at Cascadia for many years,” said Duane Hadtaja, one of three Cascadia clients at the meeting, who writes a newsletter for the nonprofit.
There’ll be a public meeting to discuss Cascadia’s future on May 29th at 6pm, in the cafeteria at Benson High school. Earlier this month, the state and county bailed Cascadia out by accelerating $1.5m in payments due to the group for work already performed. Cascadia had taken a $2m line of credit from its bank without informing the county, and thanks to the lack of proper oversight and accountability there, it was able to conceal the problems until the bank froze Cascadia’s accounts at the end of April, and it had to ask for help. Cascadia’s CEO, Leslie Ford, resigned, and has since been replaced by Derald Walker, who was also at the meeting with Wheeler yesterday.
Wheeler, who was conciliatory yesterday, said “this is no longer a dollar and cents issue, it’s a moral imperative…” to come up with a solution to Cascadia’s problems. Until a solution is offered, however, this situation puts a great deal of pressure on Wheeler to prove his mettle as County Chair in a crisis.
“We need to make sure we’re not just setting the system up for failure again,” said John Holmes, director of the Portland chapter of the National Alliance on Mental Illness.
“This is what happened in 2002-3, when the county set out to redesign the mental health system,” said Roy Silberstein, director of the Mental Health Association of Portland. “Although the difference is that they’re making an attempt this time to include consumers in the planning process. It’s encouraging because there’s a chance that consumers won’t be trampled.”
Comments
Multnomah County's mental health system was remodeled, top to bottom, with exhaustive process, in 2002-2004, culminating in the creation of Cascadia Behavioral Healthcare.
The remodel was initiated by a State review of the County's data processes, and the collapse of one of the county's five community mental health care providers, Garlington Center.
The keenest minds are not drawn to the most intractable problems: leaders in mental health administration are often square pegs hammered into round holes.
Yest unanswered is a basic question: why does the County insist on causing the turmoil of 20,000+ clients when they could just fix the accounting system?
Cascadia needs to pull it's head out of it's collective ass. For WEEKS now people at the higher levels continue a mantra of "we have been keeping late hours, "workin hard, every day:(in a George W. voice) but NOTHING ever gets decided. Hey Cascadia and County- MAKE SOME DECISIONS ALREADY! Consumers are stressed enough just in general lets make some decisions, that's what y'all are PAID TO DO! Or maybe we can ALL Take a trip to Mr. Wheeler's and Mr. Walker's front yards for a while...Hopefully they accept Verity!
I wonder if the new head of Cascadia, Derald Walker, is a CPA. If he isn't, maybe he should hire one.
I remember some 20 years ago when I used to work for a State of Oregon commission, which answered to the Governor. My boss was always trying to get away with accounting tricks. But the State had (hopefully still does) an accountant who continuously supervised all the various State commissions' books.
When my boss would whine, "I don't see why NOT??!!" The accountant, bless her shrewd heart, would purse her lips, put her fingertips together and crisply say, "It's not....neat!"
Cascadia has not been keeping neat accounts, nor bookkeeping. Apparently nobody can understand them, so hopefully that's the first thing they do, is straighten things out in that department.
Also, now that there is a move to trim down the size of the Cascadia monolith, this could be done via attrition, not by the ax throwing mental health clients on the cutting room floor, so to speak. In other words, as clients transfer or simply stop coming to providers at Cascadia for maybe six months, gradually trim down the number of clients by no longer taking new clients until the organization is the size the County wants it to be. This could take several years, and would be less painful than a sudden downsizing.
Cascadia could keep the urgent care walk in clinic. And people who come there could be seen until a the person has been assigned to one of the multitude of agencies in Multnomah County.
Angst and uncertainty are really hard for clients and employees to deal with. That said--having nearly all of the mental health services with one provider isn't necessarily a good idea.
There need to be more checks and balances in the system. People need to have a choice of providers--not just the monolithic provider.
It appears the people who use services are the county's first priority right now. It is the first time that people who use the services have been the county's first priority. I hope the county continues to put the needs of the clients first.
The former leadership of Cascadia, the State, and the County have a lot to answer for. Where was the oversight? How did a provider that provides services to so many people take out a lone without notifying the county and state that it was doing so?
I am aware that Cascadia has its own board of directors that can legally transact business including obtaining a loan. Why didn't the board president inform the county and the state that they were having to take out a loan in order to cover costs?
The cuts to human services, the Oregon Health Plan, over the past several years have also contributed to the problem at Cascadia.
Our state has disinvested in mental health services with dreadful consequences for a number of people.
I hope the legislature will see fit to realize that they played a part in the disinvestment of mental health services in the community.
snowball in hell
Public Meeting Regarding Cascadia and Multnomah County Mental Health System
[The following announcement arrived in my email from JoAnn Fuller of the County at 3:50 p.m. on Friday before the Memorial Day Weekend. A sure way to make sure people don't see it, even though it was sent to a lot of people.]
This week, Cascadia has offered the state and Multnomah County options for downsizing their organization. We are looking at a variety of alternatives. Cuts may occur in program areas or geographic areas. Services will continue, but service providers and locations may change.
All parties are committed to ensuring continuity of care, with minimal disruption for consumers.
Community feedback on the draft plan is valued. Consumers and members of the public are invited to weigh in at a meeting scheduled for Thursday, May 29, 6:00 pm to 8:00 pm at Benson High School Cafeteria (546 NE 12th Ave.)
Decisions are being informed by in-depth financial and program analysis and input from a wide variety of experts and community advocates. Our emphasis is on continued services for consumers, smooth transition of services and a viable business model.
Criteria and considerations include:
Continuity of services for mental health consumers
No single provider will provide more than 40% of the services in the adult mental health system
Maintaining staff to client ratios no greater than 50:1
Evaluating providers areas of expertise
Geographic locations of services identifying providers with a presence in each community
Keeping our excellent clinical staff within our local mental health system
County and state fiscal and program officials are committed to diligent monitoring to ensure that the system of care is fully supported. The county and the state are working together to protect the interests of the taxpayers and the services of the mental health system. The county will continue to work with all providers with regular provider meetings, and ongoing site and quality reviews to support the transition.
As we move forward, we will look at strengthening our contracts to allow for more in- depth monitoring of contracting agencies finances, increased technical assistance for business management, billing, and program development.
Cascadias financial constraints have demanded a rapid response. We are building a flexible transition plan, allowing for the potential stresses of this accelerated timeframe. We will do whatever it takes to prevent disruption of the highest priority services.
For mental health assistance please contact our Mental Health Call Center at 503-988-4888.
As more information becomes available, we will provide updates by email and post information on this website: www.co.multnomah.or.us/mh.shtml
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Wouldn't it make more sense to fix Cascadia's accounting system, than to cause extreme angst amount 20,000 Cascadia clients and their providers who would lose their jobs?
What amazes me is that Cascadia got away with incomprehensible accounting system for so long. Where were the County's and the State's oversight?
In 1998, I think it was, the Multnomah County Mental Health Task Force discovered that Unity, Inc., Cascadia's predecessor, had zilch bookkeeping. The Oregonian quoted their independent investigators as saying, "Nobody knows where the money is coming from, nor where it is going." Sounds like Cascadia's accounts are equally "creative."